Estudio de la prevalencia de quistes foliculares en dientes supernumerarios.

Entre las alteraciones del desarrollo normal de la región oral y maxilofacial se encuentran , las del número de los dientes, tanto en dentición temporal como en dentición permanente: agenesias dentales y dientes supernumerarios.Los dientes supernumerarios son una alteración de la odontogénesis poco frecuente y se define como la presencia de un número de dientes superior a la fórmula dental normal: hiperodoncia.Dependiendo de la morfología, número y localización de los dientes supernumerarios incluidos, éstos son origen de alteraciones de la erupción y desarrollo de los dientes permanentes con los que se relacionan, también pueden desarrollar un quiste folicular alrededor de su corona.Objetivos: General: Estudiar los quistes foliculares en dientes supernumerarios incluidos tratados y realizar un estudio epidemiológico y descriptivo de las características clínicas de estos pacientes.Específicos:1. Describir la morfología y localización anatómica de los dientes supernumerarios tratados.2. Determinar la presencia de quiste dentígero o folicular en los dientes tratados.3. Analizar la anatomía patológica de los quistes tratados durante la exéresis de los dientes supernumerarios.4. Verificar la coincidencia, en el mismo paciente, de dientes supernumerarios y agenesias de dientes permanentes.5. Analizar la interrelación de las variables estudiadas. Hipótesis de trabajo:H1. La incidencia de quistes foliculares en los dientes supernumerarios es superior en el sexo masculino.H2. La localización más frecuente del quiste folicular en diente supernumerario incluido es en el maxilar y concretamente en la premaxila, zona incisivo-canina.H3. los dientes supernumerarios múltiples (dos o más) presentan mayor incidencia de quiste folicular.Material y métodos: Estudio observacional descriptivo de 158 dientes supernumerarios incluidos, hallados en 112 pacientes pediátricos sanos de edades comprendidas entre los 3 y 20 años, que han sido tratados quirúrgicamente en nuestro servicio durante un periodo de 2 años y 7 meses (mayo 2005 / diciembre 2007) valorando las diferentes variables de filiación, sexo, edad, derivación, localización, número, morfología, posición-eje, diagnóstico por la imagen, abordaje quirúrgico, quiste folicular asociado y presencia de agenesias dentales. Para la clasificación de la localización hemos dividido los maxilares en 6 zonas: Z1 maxilar superior anterior, Z2 mandíbula anterior, Z3 premolares superiores, Z4 premolares inferiores, Z5 molares superiores, Z6 molares inferiores. Hemos creado una zona MD para estudiar los mesiodens, situados entre los incisivos centrales superiores.Para el diagnóstico de quiste folicular o dentígero hemos seguido los criterios definidos por Kramer, Pindborg y Shear, Daley y Wysocki y Benn y Altini:Radiología: imagen radiolúcida pericoronaria del diente supernumerario, de cómo mínimo 2,5 mm en algún punto.Exploración quirúrgica: Intraoperatoriamente, aunque en el estudio radiológico no haya sido visible, encontramos un espacio de más de 2,5 mm. entre el esmalte de la corona del supernumerario y la cortical del maxilar.Histopatología: El anatomo-patólogo realiza una descripción del tejido remitido en la que nos informa que es compatible con quiste folicular o dentígero.De estos tres criterios diagnósticos el segundo es el más subjetivo, pero los tres se cumplen en los casos de nuestro estudio.Para realizar el estudio estadístico se recogen los datos en dos hojas Microsoft Excel: 1. Con los datos por paciente (n=112) y 2. Con los datos de cada diente (n=158).Se realizan estudios con el programa Statgraphics plus versión 5.1., de cada una de las tablas de datos: Análisis descriptivo de las variables. Análisis cruzado de algunas variables, para estudiar si existe relación estadística entre ellas. Análisis de componentes principales, para visualizar la posición relativa de las observaciones (pacientes o dientes, en cada caso) respecto a todas las variables cuantitativas. Análisis cluster, crea grupos entre las variables, en función de la proximidad relativa que encuentra entre ellas.Resultados: Encontramos mayor incidencia en varones (n=71) que en mujeres (n=41), con una ratio H:M de 1,73:1. Su localización más frecuente es en maxilar superior (88,6%) y más concretamente en premaxila (78,5%), con una localización predominante entre incisivos centrales-mesiodens (65%), predomina la forma única (68,75%) de morfología conoide (60,76%). El abordaje quirúrgico para su exéresis se realizó en la mayoría de los casos por vía palatina/lingual (53,57%) frente al 41,96% por vía vestibular y hemos encontrado quistes foliculares asociados en un 24% de los casos. Discusión:Los dientes supernumerarios incluidos, como el resto de dientes no erupcionados, mantienen intacto el folículo dental que envuelve totalmente la corona y se adhiere al cuello anatómico del diente, por lo que potencialmente, todos ellos podrían presentar un quiste dentígero o folicular.En nuestro estudio hemos analizado una muestra de 112 pacientes, del área geográfica de Barcelona, no sindrómicos, intervenidos quirúrgicamente, por el mismo equipo quirúrgico, con 158 dientes supernumerarios no erupcionados, que han sido extirpados, localizados en maxilar y mandíbula, lo que hace de éste el quinto estudio en número de dientes supernumerarios, de los que hemos encontrado en la literatura. Tenemos un rango de edad entre 3 y 20 años, con una edad media de 10 años y 6 meses en el momento de la intervención quirúrgica.Los dientes supernumerarios los clasificamos según su morfología, en eumórficos o suplementales y dismórficos: conoides, tuberculados y mixtos (CTS-conoides-tuberculares-suplementales). En nuestro estudio, los conoides son los más frecuentes (61%), coincidiendo nuestros resultados con la mayoría de artículos. En cuanto a los estudios que describen, entre otras complicaciones, quistes foliculares en dientes supernumerarios, en la literatura hallamos diferencias importantes. En los tres artículos anteriores a 2004 se hace referencia al quiste folicular como complicación, en dos de ellos; pero no se reportan datos concretos o porcentaje en ninguno de ellos.En los trabajos publicados posteriormente, si se evalúan los quistes foliculares, en nuestra opinión no hay coincidencia en los criterios diagnósticos, esta es la razón de los resultados tan diferentes. Salcido-García y cols explican que en ningún caso han hallado quiste folicular en el material remitido al patólogo "sin encontrar lesiones neoplásicas ni quistes", sin mencionar el diagnóstico radiológico ni el clínico en el momento de la intervención quirúrgica.Fernández-Montenegro y cols. y Liu DG y cols. en sus respectivos artículos encuentran unos porcentajes muy similares, creemos que el diagnóstico fue de quistes foliculares "grandes", muy evidentes en las radiografías.Por último encontramos en el artículo de Leco-Berrocal y cols. un resultado muy similar al nuestro, aunque con un número de dientes supernumerarios pequeño (n=24), creemos que los criterios diagnósticos son los mismos que en nuestro estudio: Imagen radiológica pericoronaria mayor a 2,5 mm. en algún eje, diagnóstico clínico intraoperatorio y un informe histopatológico confirmando lo anterior y descartando otras patologías.En nuestro estudio no queda validada ninguna de las tres hipótesis planteadas.Conclusiones: La forma más común es el conoide (60%), un diente supernumerario único (69%) y en cuanto a la localización, el 88% se encuentran en el maxilar superior y el 78% en la premaxila.La morfología y localización anatómica de los dientes supernumerarios incluidos tratados, son muy similares a las descritas en los estudios anteriores.Hemos encontrado un 24 % de los dientes supernumerarios incluidos, tratados, que cumplen los criterios diagnósticos de quiste folicular.La histopatología de los quistes dentígeros o foliculares de nuestro estudio ha sido siempre compatible con los criterios diagnósticos de la OMS (WHO).Hemos encontrado un paciente en el que coinciden dientes supernumerarios y agenesia dental.Los estudios estadísticos multivariantes, de las variables cuantitativas agrupadas (pacientes o dientes supernumerarios) estudiadas conjuntamente nos permiten afirmar:Mediante el análisis de componentes principales (ACP), que tienen una gran relación el sexo femenino con los mesiodens, la zona anterior del maxilar y la forma conoide.Utilizando el análisis cluster de dientes y pacientes, que están relacionados el quiste dentígero o folicular con la zona de molares superiores y el supernumerario con forma mixta (CTS).Propuestas de futuro: Desarrollar esta línea de investigación clínica con proyectos de nuestro departamento y además realizar estudios interdepartamentales en nuestra facultad. Seguir estudiando casos en que coincidan agenesias. Estudiar la aplicación de la tomografía computerizada y la tomografía volumética en haz de cono, especialmente en la planificación de los casos. Realizar estudios multicéntricos para así aumentar la muestra y poder obtener resultados más relevantes. Finalmente, también desarrollar estudios conjuntos con el departamento de Biología Celular y Molecular con proyectos de investigación como el cultivo de células madre procedentes de folículos o pulpas dentales de dientes incluidos; ya se han obtenido resultados preliminares muy esperanzadores

Implant-supported fixed prostheses in a Patient with Osteogenesis Imperfecta : a 4-year follow-up

Osteogenesis Imperfecta (OI) is a rare autosomal dominant connective tissue disorder in wich, the bone quality and density is affected. OI includes some metabolic disorders and have a wide range of clinical presentations. In Osteogenesis Imperfecta bone has a very low density and it is a disorder currently treated with bisphosphonates. Quality and quantity of bone is important for establishment of osseointegration in dental implants. There are few reported cases in the literature. This is a case report of a 61 year-old man with grade IV OI, rehabilitated with implant-supported fixed prostheses in the posterior right and left mandible, whithout bone grafts. At the 4-year follow-up, clinical and imaging study showed no evidence of pathology in the peri-implant tissues. The final outcome is a correct occlusion and masticatory function. This case shows that dental implants may be a treatment option in this patients, however there is still quite limited scientific evidence

A descriptive study of 113 unerupted supernumerary teeth in 79 pediatric patients in Barcelona

Unerupted supernumerary teeth, depending on the morphology, number and distribution can give rise to various alterations in the eruption and development of those permanent teeth to which they are related. Objectives: We aimed to make an epidemiological and descriptive study of the clinical characteristics of patients in Barcelona, their surgical treatment and how said treatment was hindered. Materials and methods: A descriptive study including 113 supernumerary teeth from 79 healthy pediatric patients between 5 and 19 years of age, which underwent surgery in our hospital during a 2 year period (May 2005 / May 2007), taking into account the variables of personal data, gender, age, location, number, morphology, positionaxis, radiological study, surgical treatment, related pathologies, and surgical complications. Results: Male patients (51) were more frequently affected than female (28) patients mainly within the central incisors-mesiodens (53.16%), in which the unique form (68.52%) predominates in conoid morphology (69.62%). Surgical treatment was done by palatal/lingual extraction (49.37%), with few surgical complications (only 1 case of post-surgical bleeding). Conclusion: Incidence in supernumerary teeth is higher among male patients (ratio M:F of 1.82:1). They are most frequently located in the maxilla (82%), specifically, in the premaxilla (77%). Most cases presented only one supernumerary tooth (68.5%) and, in multiple cases, the premolar region is predominant. The conoid shape is the commonest morphology (69.62%). Surgical extraction, was done by palatal/lingual in 49.37% of the cases, as opposed to the vestibular approach in 45.57%

Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol

Background: Partial ankyloglossia is a limitation which restricts the possibility of protrusion and elevation of the tip of the tongue due to the shortness of either the lingual frenulum or the genioglossus muscles or both. The principal objective of this paper is to present our protocol of action for the treatment of ankyloglossia. The specific objectives are to study patients with ankyloglossia treated by the Service of Maxillofacial Surgery and the Service of Speech Therapy of our pediatric Hospital, describe the diagnostic procedures, the pre-surgical intervention, the surgical technique undertaken and the post-surgical rehabilitation taking into account the level of collaboration of the patients, and finally, describe the surgical complications and the referral of patients. Material and Methods: This is a descriptive study of healthy patients, without any diagnosis of syndrome, ranging between 4 and 14 years that have been surgically treated and rehabilitated post-surgery within a period of 2 years. Results: 101 frenectomies and lingual plasties have been performed and patients have been treated following the protocol of action that we hereby present. After the surgical intervention, the degree of ankyloglossia has been improved, considering correction in 29 (28%) of the patients (95% CI: 20%, 38%), reaching, with the post-surgical orofacial rehabilitation, a correction of 97 (96%) of the participants (95% CI: 90%, 98%). Conclusions: The chosen surgical technique for moderate-severe ankyloglossia in our centre is the frenectomy and lingual plasty. The myofunctional training begins one week before the surgical intervention so that the patients learn the exercises without pain

Envelope approach for onlay bone grafting : preliminary surgical and prosthetic results

Minimally invasive surgery principles have been applied to preprosthetic-implant surgery, and an adequate presurgical planning reduces morbidity in both harvesting and stabilization of the bone grafts. Objective: A new ?envelope? approach for onlay bone grafting at the alveolar process is presented, this avoids releasing incisions yet allowing adequate reconstruction of the defective site. Study design: To be included in the study the patient had to have an antero-posterior defect of the alveolar crest. Patient age and sex, location of the defect, type and size of graft, and complications appeared during follow up were recorded. Results: Ten consecutive patients (4 men and 6 women) have been succesfully treated with this technique between June/2006 and February/2008. Eight defects were located at the anterior maxilla (between canines), and the remaining two at the anterior mandible (between canines). Four patients received bone grafts harvested from the chin, and the remaining six patients received bone grafts from the mandibular body. Mean size of the graft was: width 11,5mm (range 8 to 17), height 14,7mm (range 9 to 18), depth 4,3mm (range 3 to 6). Conclusion: This technique improves vascularization of the mucoperiosteal flap and avoidance of releasing incisions which has an aesthetic impact in patients with gingival smile

Histologic and histomorphometric evaluation of a new bioactive liquid bbl on implant surface: a preclinical study in foxhound dogs

Background: bioactive chemical surface modifications improve the wettability and osse-ointegration properties of titanium implants in both animals and humans. The objective of this animal study was to investigate and compare the bioreactivity characteristics of titanium implants (BLT) pre‐treated with a novel bone bioactive liquid (BBL) and the commercially available BLT‐SLA active. Methods: forty BLT‐SLA titanium implants were placed in in four foxhound dogs. Animals were divided into two groups (n = 20): test (BLT‐SLA pre‐treated with BBL) and control (BLT‐SLA active) implants. The implants were inserted in the post extraction sockets. After 8 and 12 weeks, the animals were sacrificed, and mandibles were extracted, containing the implants and the surrounding soft and hard tissues. Bone‐to‐implant contact (BIC), inter‐thread bone area percentage (ITBA), soft tissue, and crestal bone loss were evaluated by histology and histomorphometry. Results: all animals were healthy with no implant loss or inflammation symptoms. All implants were clinically and histologically osseo‐integrated. Relative to control groups, test implants demon-strated a significant 1.5‐ and 1.7‐fold increase in BIC and ITBA values, respectively, at both assessment intervals. Crestal bone loss was also significantly reduced in the test group, as compared with controls, at week 8 in both the buccal crests (0.47 ± 0.32 vs 0.98 ± 0.51 mm, p < 0.05) and lingual crests (0.39* ± 0.3 vs. 0.89 ± 0.41 mm, p < 0.05). At week 12, a pronounced crestal bone loss improvement was observed in the test group (buccal, 0.41 ± 0.29 mm and lingual, 0.54 ± 0.23 mm). Tissue thickness showed comparable values at both the buccal and lingual regions and was significantly improved in the studied groups (0.82–0.92 mm vs. 33–48 mm in the control group). Conclusions: Relative to the commercially available BLT‐SLA active implants, BLT‐SLA pre‐treated with BBL showed improved histological and histomorphometric characteristics indicating a reduced titanium surface roughness and improved wettability, promoting healing and soft and hard tissue regeneration at the implant site.This research was funded by: Biointelligent Technology Systems SL, Barcelona, Spain

Immediate implants following tooth extraction. A systematic review

Objectives: The aim of this article is to review the current state of immediate implants, with their pros and contras, and the clinical indications and contraindications. Material and Methods: An exhaustive literature search has been carried out in the COCHRANE library and MEDLINE electronic databases from 2004 to November 2009. Randomized clinical trials and clinical trials focused on single implants placed in fresh extraction sockets were included and compared. A meta-analysis could not be performed due to heterogeneity of the data. Results: Twenty studies out of 135 articles from the initial search were finally included, which summed up a total of 1139 immediate implants with at least a 12-month follow-up. Our results have been compared with other current available papers in the literature reviewed that obtained similar outcomes. Discussion: Immediate implants have predictable results with several advantages over delayed implant placement. However, technical complications have been described regarding this technique. Also, biomaterials may be needed when the jumping distance is greater than 1mm or any bone defect is present. Conclusions: Few studies report on success rates rather than survival rates in the literature reviewed. Short-term clinical results were described and results were comparable to those obtained with delayed implant placement. Further long-term, randomized clinical trials are needed to give scientific evidence on the benefits of immediate implants over delayed implant placement. © Medicina Oral S. L

A novel trephine design for sinus lift lateral approach. Case report

Various techniques are described in the literature, either by crestal or lateral approach. Sinus augmentation has a high percentage of success, but presents a number of intraoperative and postoperative complications. The most frequent complication is the Schneiderian membrane perforation with a percentage of perforations between 11% and 56% according to authors. The aim of this study is to describe another membrane approach technique for the sinus lateral wall osteotomy that minimizes the risk of Schneiderian membrane perforation. We present a case of a 50 year old patient attended the University Dental Clinic (UDC) of International University of Catalonia for implant and crown treatment due to the loss of a right maxillary first molar. To insert an implant in position 1.6 a computerized tomography (CT) was requested to determine with greater accuracy the quantity of residual crestal bone. It showed a height of 5 mm and width of 8 mm. The lateral osteotomy was performed with a (SLA KIT® -Neobiotech) trephine mounted in the same implant handpiece with which the field for the implant and the implant itself were prepared. It can be concluded that in the case described, the use of trephine drills of the SLA system mounted in a handpiece allows better access to lateral approach due to its perpendicular position relative to the sinus wall minimizing the membrane perforation risk

Relation between bone density and primary implant stability

Aims: This study aims to relate bone density in Hounsfield units (Hu) with the primary implant stability measured by insertion torque (Ncm) and resonance frequency analysis (ISQ). Materials and Methods: Ten patients were included in this study. A total of 54 implant sites were provided from 10 computerized tomography scans. The computerized tomography scan was used for the preoperative evaluation of bone density for each patient. The bone mean density around planned implants was determined with Physioplanet TM software. Bone quality according resistance to drilling, insertion torque and resonance frequency measurements were recorded. Results: A statistically significant relationship was observed between bone quality density and location with ISQ values. Conclusions: This research demonstrates a strong relationship between the bone density values from computerized tomography and the location in the maxillaries. A correlation exists between bone quality, according to the Lekholm and Zarb classification, and Hu computerized tomography values. The primary implant stability measured with resonance frequency analysis depends on bone density values, bone quality and implant location

Chemically defined conditions mediate an efficient induction of dental pulp pluripotent-like stem cells into hepatocyte-like cells

Liver diseases are major causes of morbidity and mortality. Dental pulp pluripotent-like stem cells (DPPSCs) are of a considerable promise in tissue engineering and regenerative medicine as a new source of tissue-specific cells; therefore, this study is aimed at demonstrating their ability to generate functional hepatocyte-like cells in vitro. Cells were differentiated on a collagen scaffold in serum-free media supplemented with growth factors and cytokines to recapitulate liver development. At day 5, the differentiated DPPSC cells expressed the endodermal markers FOXA1 and FOXA2. Then, the cells were derived into the hepatic lineage generating hepatocyte-like cells. In addition to the associated morphological changes, the cells expressed the hepatic genes HNF6 and AFP. The terminally differentiated hepatocyte-like cells expressed the liver functional proteins albumin and CYP3A4. In this study, we report an efficient serum-free protocol to differentiate DPPSCs into functional hepatocyte-like cells. Our approach promotes the use of DPPSCs as a new source of adult stem cells for prospective use in liver regenerative medicine.This study was funded by the Universitat Internacional de Catalunya (UIC), the Agència de Gestió d’Ajuts Universitaris i de Recerca, Generalitat de Catalunya project number (SGR 1060 for MA), the Kuwait Foundation for the Advancement of Sciences (KFAS), and the Dasman Diabetes Institute under project number (RA-2013-009 for AAM). CGR, EMS, and RNT were funded by the predoctoral grant Junior Faculty award from the Obra Social, 'la Caixa' Foundation, and UIC